School of Nursing students at Missoula College participate in classroom simulations in September, 2018. Credit: Photo courtesy of Missoula College

MISSOULA — Until early March, Missoula College nursing student Matt Powers hadn’t anticipated that the global coronavirus pandemic might interrupt his studies. The inevitability of the disease’s spread to Montana first dawned on him as he watched a flight radar display at Missoula International Airport, where he works part-time as a ground handler. But it wasn’t until he returned from a clinical rotation at the state hospital in Warms Springs the week before spring break that the impact on his program came into focus. Sitting on his couch with his 4-year-old son, Powers read an email informing him that all clinical rotations for nursing students — referred to as “clinicals” — were canceled for the remainder of the semester.

“I think my first reaction was I just tossed my phone on the couch,” Powers said. “My first thought was, ‘We’re totally not going to be able to graduate in December.’”

Now Powers’ classes are entirely online. Faculty are still working on ways to supplement the lost hours of hands-on learning in class labs and health care facilities, and hoping that those facilities will be in a position to reopen to students in the summer and fall. Linda Barnes, director of Missoula College’s nursing program, said students who are scheduled to graduate in May are still on track to do so, but it’s still too early to tell for those slated to graduate in December.

“I really don’t have any foresight at this point to be able to say that they’re going to be delayed or not,” Barnes said. “It’s just totally going to depend on when the hospitals open back up for students. It’s all about their clinical hours, really, and getting those done.”

The same story has played out across the country in recent weeks, with health care facilities and nursing programs alike canceling in-hospital learning opportunities that are required for students to obtain their degrees.

One reason for the cancellations is the potential transmission of the coronavirus from patients to students, and vice versa; groups of students in Washington and California were forced into two-week quarantines this month after potentially being exposed to the disease during health care training.

Another reason is the added strain that students in clinical environments would put on the stores of personal protective equipment that hospitals nationwide note are already in dangerously short supply.

“This is the time when we really need to preserve those scarce supplies for our frontline care providers,” said Sarah Shannon, dean of Montana State University’s College of Nursing. “So it’s appropriate for us to not be using those supplies for the student learner who is there beside the care provider.”

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According to Shannon, the cancellation of clinical rotations at MSU began in mid March after several assisted-living facilities in the Bozeman area requested that the college stop sending nursing students. The Montana Board of Nursing noted in a March 13 memo to all Montana nursing education program directors that it had received multiple reports of clinical sites across the state “closing their facilities to students for an indefinite period of time.” Barnes said three nursing students attended management clinicals in Missoula over spring break, but were not in direct contact with patients. She made the call to cancel all Missoula College clinicals on March 23, the same day Shannon canceled all clinicals for MSU students.

“As the director of this program, I decided on that date,” Barnes said. “It was not driven at all by the hospitals.”

On March 26, the National Council of State Boards of Nursing released a policy brief proposing that nursing programs and health care facilities partner during the COVID-19 pandemic to allow students to work full- or part-time to augment and support nursing services. The approach, NCSBN stated, could help alleviate the twin problems of canceled clinicals and the anticipated demand on the nursing workforce.

Clinicals aren’t just an invaluable source of hands-on learning. The hours that students spend on rotation in medical facilities are a state requirement for entering the workforce, and are focused on specific areas of health care including pediatrics, adult nursing, and mental health. Students’ ability to make up for the hours lost to cancellations is limited by state-specific caps on the percentage of clinical hours that can be met through classroom simulations or academic case studies. Several nursing program leaders in California wrote a letter to Gov. Gavin Newsom on March 18 saying that the cancellation of clinicals due to the coronavirus rendered them unable to meet the California state requirement that 75% of clinical hours be completed through direct patient care. The letter urged Newsom to adopt emergency guidelines allowing students to meet program objectives via distance education, and noted that California would “face a serious nursing shortage during a public health crisis if students do not graduate on time.”

“I understand why it’s happening, but that is a huge learning tool that I feel like will affect a lot of nursing students, in terms of being allowed to apply the knowledge that they’ve acquired.”

—Missoula College nursing student Amanda Costner

According to Executive Officer Missy Poortenga, the Montana Board of Nursing held a meeting March 24 to discuss the impact of the state’s 50% simulation-education cap, having encouraged nursing programs in its March 13 memo to reach out with concerns about breaching that cap.

Montana graduates an average of 650 nursing students annually from 14 nursing programs statewide. With the nation already in the midst of a nursing shortage, the Montana Department of Labor and Industry has identified those graduates as highly valued additions to the workforce; Sen. Jon Tester’s office put the shortage of nurses in Montana at roughly 800 in 2018.

“From discussions with programs around the state, I do not anticipate current concerns delaying entry into [the] workforce or contributing to [a] shortage,” Poortenga said via email.

Amanda Costner, another Missoula College nursing student slated to graduate in December, said she’s disappointed about the potential loss of experience due to canceled clinicals. She completed one 24-hour mental health rotation at Warm Springs prior to spring break. A second rotation was canceled, as were both of her pediatric clinicals. It remains to be seen when or if those clinicals will be rescheduled.

“I understand why it’s happening, but that is a huge learning tool that I feel like will affect a lot of nursing students, in terms of being allowed to apply the knowledge that they’ve acquired,” Costner said. “I’m a hands-on learner, so that is really a big thing for me, not having clinicals.”

The crisis does offer a unique educational opportunity, one that MSU recognized quickly. Shannon said that during spring break her program developed an eight-hour learning module focused entirely on the coronavirus, the nature of the COVID-19 disease that it causes, and the history of pandemics. Students were required to complete the module during their first week back from the break.

For Barnes, the changes to course structure stemming from the outbreak serve as a valuable lesson for students on the need for nurses to adapt quickly to change.

“When they’re working as a nurse, things are changing daily and hourly, and they’re always going to have to be flexible,” Barnes said. “So I hope that this experience teaches them some patience, and some ability to roll with the punches and be able to adapt to a different learning environment.”

Other than the canceled clinicals, Costner and Powers both said their studies have continued apace. Instructors are teaching classes remotely, readings still have to be completed, and tests are being administered through online platforms the program has utilized for years.

Powers continues to work at the airport, and at a second part-time job as a health unit coordinator in pediatrics at Missoula’s Community Medical Center, and Costner still attends her job as a dental assistant at Partnership Health Center. That job has given her a window into how health care facilities are dealing with the coronavirus, as all patients are screened for COVID-19 symptoms when they arrive, and appointments are rescheduled for those who show signs of the disease. Asked if the personal risk that frontline health care professionals face during the pandemic has made her question her decision to go into nursing, Costner went the other way.

Alex Sakariassen

Freelance writer Alex Sakariassen has spent the past decade writing long-form narrative stories that spotlight the people, the politics, and the wilds of Montana. A North Dakota native, Sakariassen splits his free time between Missoula’s ski slopes and the quiet trout water of the Rocky Mountain Front. Contact Alex by email at alex.sakariassen@gmail.com.